By.a professional nurse or other health care providers of therapeutic services such as

PT/OT/Speech Therapy

Medical Social Work

Personal Care , Home Health Aide services.

Setting is usually the home or some other non-institutional setting.

4A wee bit of history.

1700s- Religious orders went out into peoples homes to care for sick

Early 1800s- Boston Dispensary then District Nurses across country

Late 1800s- Visiting Nurses Associations

1900s -VNAs, Public Health Departments

5Some key players.

Florence Nightingale

Lillian Weld

Mary Brewster

Mary Breckenridge

6History.

1965- Medicare/ Medicaid Legislation

HUGE Impact--payors for services

To date MEDICARE is 1 Payor of Home Care Services

1982-DRGs- Limited the for Hospitilized Care, so patients were discharged from hospitals Quicker and Sicker

Huge ? the use of Home Health Care

1990s- Influences of Managed Care

Use of Guidelines/Pathways

Contracting for Services

Captitation of payment

72000s...

Introduction of HHRGs PPS

Home Health Related Groupings PPS

In place as of October 1, 2000

High impact on the way Home Health Agencies are functioning

The way agencies are paid effects the way the function

high component

8CHANGE..... 9Medicare/Medicaid

Medicare

Federally funded as part of Social Security

Provision of care for anyone in the U. S. Age 65 or older

Managed by HCFA and Intermediaries

2 Parts

Part A-Reimburses for hospital and post- hospital care ( including Home Health Care)

Funded totally from SS

Part B- Reimburses physician charges, Lab fees, therapies, supplies

Funded from premiums

10Medicaid

State funded

MediCal

Designed to cover

Children

Low income adults in need of health care

Disabled

Medically indigent

Varies state-state

Colorado Vs Utah

11Medicare Will pay the Agency For Home Care Services if.

1. Patient is Homebound ( Unable for health reasons to leave the home)

2. Be in Part-Time or Intermittent need of skilled , non-duplicative care from one of the following care providers

Nursing and/or PT/OT/Speech

3. Have a documentable medical necessity

4. Be under the care of a physician

5. Have a Plan of Care

12Home Care Today..TRENDS

Rapidly Growing Field

1963-1000 agencies

1997-21,000 agencies

Sicker and sicker patients

? Technology in the home setting

? Variety in Home Health

not all the elderly, also

Pediatrics, Neonate Care

Mental Health Care

? Cost Savings Home Vs Hospital

Example Vent Dependent--22,000 month in Hosp, 7,000 month at home

13TRENDS Cont...

Increase in regulations

Importance of documentation

Increased emphasis on QUALITY of CARE, how to prove its there

? Computerization--Transfer of Information

? Influence of Managed Care

? Concern over Safety Issues

Growth of Hospice services

14Nursing in the Home Vs in the Hospital

Healing Environment for Patients, Families

Patients and Families have feeling of more control

Same Nursing Process

A D P I E

Emphasis on Family The Primary

Caregiver

Education is Critical

Multidisciplinary Team, NURSE is key coordinator, ROLES..

15Home Health Treatment Plans

Diagnosis

Functional limitations

Anticipated length of care

Type and frequency of services needed

Medications

16Treatment plans (cont)

Diet

Activities permitted

Medical supplies and appliances

Safety measures in home environment

Mental status

Orders and treatments

Goals/Rehab potential/ DC plans

17Treatment plans

Must be reviewed and updated every 60 days.

Assessment visit okay without Dr. order

18Some Case Examples

???

19Case Study 1

A 28-year-old female was admitted to your med-surg unit after suffering a hip fracture in a bad skiing accident, You anticipate this patient being sent home in a large cast. She works part-time for a local manufacturing firm and states she is married with two children.

20Case Study 2Help

A 78-year-old male, Harold P., was admitted to your telemetry unit from CCU after undergoing open-heart surgery for 3-vessel bypass. His wife states that she has severe rheumatoid arthritis and that because of her disabilities, Harold prepares most of the meals and performs the housework. They have a 50-year-old daughter who lives in Grand Junction. Harold and his wife live in Meeker on the family ranch. Harold develops a post-op infection of the sternal incision requiring involved dressing changes BID and IV therapy with Amphotericin B. As Harolds primary nurse, you are actively involved in his discharge planning.

21Case Study 3

Mrs. Whelan, who is 76, is sent home from St. Elsewhere hospital with a new colostomy after bowel surgery to remove an obstruction. Mrs. Whelan is weak, lives alone and has a history of depression

22Case Study 4

Mr. Colson, who is 86, recently moved in with his daughter. Two months ago he was admitted to the hospital with urinary problems and pain. In the hospital he was diagnosed with cancer of the prostate. Mr. Colson has a catheter, is essentially bedridden and is teary as he misses his own home and friends. Mr. Colsons daughter is in her mid sixties, had arthritis and is raising her 12-year-old granddaughter.

23Case Study 5

Greg is a 19-year-old who was referred to your home care program from St. Nowhere Medical Center after a lengthy hospitalization due to a motorcycle accident. The history states that Greg went over an embankment and had significant trauma to his right leg some six months prior to this referral. He recently had surgical removal of the hardware placed during the extensive trauma surgery which immediately followed the accident. He is newly diagnosed with osteomylitis of the right knee. He has a methicillin resistant staph infection and is to receive Vancomycin per the physician orders. Greg has an immobilizer and is non-weight bearing on admission to home care.

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